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CONVERSATIONS!

The International Newsletter For Those Fighting Ovarian Cancer

THIS FORM IS FOR NEW SUBSCRIPTIONS ONLY.

IT CAN NOT BE USED TO RENEW OR CONFIRM STATUS

Yes       No Please send the newsletter "CONVERSATIONS!" on a regular basis.
Send it:
It is OK to print my:
Yes       No Do you belong to a support group of any kind (couples, women's cancer, gyn cancer, etc). Please send me the leader's name, address, and phone number and other information about the group so that I can tell others about the group.

IF "YES" -Please use the area below to enter support group information:

Matching service: If you are interested in talking to others who might have similar interests or circumstances, there is a pen pal/phone pal matching services called "VOICES". An example of how this works: Let's say you are 35 and have 3 young children and you want to talk with someone else who also has young children, then we can give you their name. Other reasons people want to connect are: age at diagnosis, stage at diagnosis, unusual cell type, unusual chemo drug or treatment, other health conditions such as diabetes or colostomies, family history of cancer, etc. Matches are based upon known information about you and others. Please be sure your info is correct and current for best possible matches. Matches are made upon request.
Yes       No It is OK to give other fighters of ovarian cancer my name (address, phone, e-mail, etc) for more direct, and faster, contact when they have information which might be helpful to me or when I can possibly help them.

PERSONAL INFORMATION Fields with * are mandatory

*First Name:
 * Last Name:
 Date of Birth: (mm/dd/yyyy)
Company:
 Title:
 Marital Status:
Company Address:
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*Home Address:
 *Country:
*City:
 *State:
 *Postal Code:
*Home Phone: (area code first)
 Work Phone: (area code first)
 Fax Phone: (area code first)
*E-Mail Address:
 Web Site Address:
*Date of Diagnosis: (mm/dd/yyyy)
 Stage:
 Cell Type:

Please use the area below to comment about your medical history, hobbies, family, etc.:

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